Scheen André, Delanaye Pierre, Lancellotti Patrizio
Service de Diabétologie, Nutrition et Maladies métaboliques et Unité de Pharmacologie clinique, CHU Liège, ULiège, Belgique.
Service de Néphrologie, Dialyse et Transplantation, CHU Liège, Belgique.
Rev Med Liege. 2024 Oct;79(10):676-682.
Injectable semaglutide at a dose of 1 mg once weekly has been shown to be the most efficacious glucagon-like peptide-1 receptor agonist when considering both the improvement in blood glucose control and the reduction in body weight in patients with type 2 diabetes (T2D). After the SUSTAIN-6 study, published in 2016, which demonstrated not only the good safety but also already the cardiovascular (CV) efficacy of semaglutide in patients with T2D and high CV risk, several large placebo-controlled randomised trials have confirmed improved prognosis with semaglutide in different at risk populations : patients with T2D and chronic kidney disease (FLOW trial), subjects with obesity and heart failure with preserved ejection fraction, with or without T2D (STEP-HFpEF trial) and people with overweight or obesity (but without T2D) and a confirmed atheromatous cardiovascular disease (SELECT trial). Studies performed in patients with obesity used a higher dose of 2.4 mg/week. These positive results, based upon major clinically relevant outcomes, extend the therapeutic possibilities with semaglutide among at high risk patients of cardiovascular and/or renal diseases.
考虑到2型糖尿病(T2D)患者的血糖控制改善和体重减轻情况,每周一次注射1毫克司美格鲁肽已被证明是最有效的胰高血糖素样肽-1受体激动剂。2016年发表的SUSTAIN-6研究不仅证明了司美格鲁肽在T2D和高心血管风险患者中的良好安全性,还证明了其心血管(CV)疗效。此后,几项大型安慰剂对照随机试验证实,司美格鲁肽在不同风险人群中改善了预后:T2D和慢性肾脏病患者(FLOW试验)、肥胖且射血分数保留的心力衰竭患者,无论有无T2D(STEP-HFpEF试验),以及超重或肥胖(但无T2D)且确诊患有动脉粥样硬化性心血管疾病的人群(SELECT试验)。在肥胖患者中进行的研究使用了更高剂量的2.4毫克/周。这些基于主要临床相关结果的阳性结果,扩展了司美格鲁肽在心血管和/或肾脏疾病高危患者中的治疗可能性。